New shoulder surgery offers local man new lease on life

By RIMSIE MCCONIGArmcconiga@leavenworthtimes.com

Friday

Feb 1, 2019 at 8:52 PM

Craig Schale has been physically active his whole life.

By RIMSIE MCCONIGArmcconiga@leavenworthtimes.com

Craig Schale has been physically active his whole life. This Army veteran and avid outdoorsman was active in sports from an early age through college. He played football, wrestled, did weightlifting and other activities. He said distance running and being in the infantry in the Army contributed greatly to his physical health.He loved hiking, fishing and playing with his grandchildren, but in the early 2000s, his shoulder began to cause him pain.

“I thought I had strained it or hurt it in some way and that it would be OK,” says Craig. “The pain would go away then in maybe a week or two would return. Most of the effect on my daily activities would be some pain that I just lived with and continued on.”The pain never really went away but he didn’t want to cut back on his activities. “I guess I was stubborn and just realized that I wasn’t as young as I thought I was. There were some activities that I had some problems doing such as throwing a football and at times fishing was cut short because of pain in my shoulder. It wasn’t upsetting because I knew that I was getting older and those things I used to do would eventually get harder as my body continued to age. This didn’t mean I was going to quit doing all the things I loved to do, it just meant I was going to have to slow down.”In addition to aging, Craig attributed the pain to playing sports when he was younger and the physical demands of the Army. “I would have to say that after 22 years in the Army, that probably played a part in it since I was in the light Infantry, we trained a lot and carried everything in our rucksack which might also have played a part,” says Craig.

But when the pain started lasting longer, he decided there might be something else wrong. He didn’t want to take pain pills so he decided to seek help. “My range of motion had decreased and there was more pain when I was doing easy tasks such as throwing a football or a baseball with the grandkids,” says Craig. “I went to see my primary care manager at Fort Leavenworth, Dr. Richard Bergstrand. He ordered an MRI to see what was going on with my shoulder. What it showed was a small tear in the rotator cuff but more than that was the deterioration of the shoulder socket due to arthritis which is basically joint degeneration.” Dr. Bergstrand recommended he see Dr. Shannon Carpenter, a specialist in shoulder surgery. After examining his shoulder for range of motion and pain level, she had ordered numerous X-rays and reviewed an MRI. The problem, she explained, was osteoarthritis.

“Dr. Carpenter said that to alleviate lack of range of motion and the pain we could do surgery,” says Craig. “She explained to us the traditional primary shoulder replacement which consists of a long stem down in your arm into the bone. She also told us about a new procedure here in the States called Simpliciti Shoulder System Joint Replacement. She told us it had never been done in this area and I was young enough to have this type of surgery.” The shoulder system joint replacement was first available in 2015 and that is when Dr. Carpenter began regularly implanting them in patients.

“I was able to use the system before it was widely available because the location where I trained was involved in the IDE (investigational device exemption) study that collected data for the device to be approved by the FDA,” says Dr. Carpenter.The device is designed to wedge into the bone at the very top of the humeral canal. The surface of the device also encourages bony ingrowth and a strong connection between the device and the patient’s bone. This allows the device to be well fixed without the need of a stem, which enables the patient’s bone to be preserved, less surgery time, less blood loss, theoretically less pain, and an easier revision down the road (if necessary.)

While stemless shoulder replacements have been used for decades overseas, this is the first stemless shoulder replacement approved in the U.S. Dr. Carpenter says that stemless prosthesis usage is exponentially increasing and several other companies are already putting out similar type products because they realize this is a critical need. “This device is innovative because it allows the surgeon to leave more of the patient’s bone intact,” says Dr. Carpenter. “Increased bone stock is important because we are putting devices in people at younger ages, and we are also living to be much older, so the likelihood that someone may need a revision of their shoulder replacement in their life is increasing. The more bone you have to work with futuristically, the better the outcome of your revision surgery. Additionally, it allows for a more natural recreation of the patient’s anatomy, thereby improving function and range of motion. I tell my patients that there is no such thing as ‘minimally invasive’ surgery. Surgery, by definition, is invasive. However, this product does allow for a quicker, less traumatic surgery with decreased instrumentation of the humerus and therefore less disruption of the normal anatomy. This leads to less blood loss, and decreased risks that come with a stem, such as a break of the bone just past the stem, called a periprosthetic fracture.”When asked if he was wary of being the first person in the local area to have this type of shoulder replacement Craig says he was thrilled to be the first – just not too thrilled about having a long stem placed into his arm.

“Like most surgery recoveries there was a lot of pain,” says Craig. “Basically, when you have an operation it takes some time for the pain to lessen as the healing starts. Also, my arm was in a sling for about six weeks. So things like taking showers were a little harder. After the surgery Dr. Carpenter started physical therapy. That hurt at first but I also know if you are going to recover and have the full range of motion it is required. The pain for the first few weeks of physical therapy was tough, but I knew I had to push myself to get through it.”

“The limiting step of a total shoulder replacement is the healing of a tendon we have to take down to place the shoulder, the subscapularis,” says Dr. Carpenter. “I tell my patients it takes six to 12 weeks for this tendon to heal. So, although the Simpliciti system cannot accelerate the time it takes the body to heal this tendon, I have seen people return to activity and function sooner with this prosthesis over others.” Although doctors are not sure what causes shoulder arthritis, Dr. Carpenter says a lot of her patients were in the military performing heavy duty overhead activities and carrying heavy rucksacks. She also treats a lot of mechanics, laborers and powerlifters for shoulder problems.

“Shoulder problems can happen to anyone who works with their arms a lot, especially overhead and with weight,” she says.Craig is back to doing all the things he loves, like playing ball and wrestling with his grandkids. And he has no problem spending the whole day fishing. He says as far as full-range motion, he is back to about 96 percent and he is pain-free since the surgery.“First of all Dr. Carpenter is a top-notch surgeon and will you tell up front everything that is going to happen,” says Craig. “And Providence Medical Center is outstanding at providing medical care to their patients. If you are having trouble with your shoulder I would highly recommend looking at this type of procedure. You have to push yourself in recovery with physical therapy, I am here to tell you that was the hardest part because it is painful and you might want to quit but the results are worth it.”

As an early adopter of the stemless shoulder prosthesis in the metro Kansas City area, Dr. Carpenter says she usually recommends the Simpliciti surgery for anyone who has shoulder arthritis with an intact rotator cuff, and she believes that the best results come from an individualized approach to each patient and determining a custom solution for their problem. She tailors the prosthesis she provides to her patients based upon the severity of their problem, age, level of activity and quality of bone.Most of her patients come to her because of pain that prevents them from doing their normal activities of daily living, and decreased range of motion that limits them from doing things that they enjoy or need to do for everyday life. She says that people are particularly miserable once they have difficulty sleeping due to their shoulder pain. For Craig it’s been a new lease on life. “There’s not a lot that I can’t do now. I’m just being active and not worrying about any pain in my shoulder. “I just want to stay active and keep up with the grandkids plus enjoy life to the fullest.”

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